The art of skin tightening
Photoaged skin is a challenge for most women over 40 years old. The prolonged exposure to UV radiation disrupts skin structure on both epidermal and dermal level. Briefly, Keratinocyte and Melanocytes activity will be affected resulting in irregular cellular division and melanin production, respectively. The Extracellular matrix will be changed as well due to higher enzymatic activity. The end results will be rough, dull skin with pigmentation lesions and deep wrinkles.
With many different technologies available now such as microneedling, fractional non-ablative laser, microdermabrasion, filler and nanosecond laser, how an aesthetic medical professional would choose the best treatment?
- First of all, for us at Albany Cosmetic and Laser Center, we make sure that our patient understands that 20 years of sun exposure will not be erased in one treatment, regardless of the chosen treatment. Therefore, we always offer a treatment package and maintenance package rather than a single treatment.
- Secondly, we try to understand the client main complaint so we can be on the same page as her. Remember, it is her face, not yours. and she should be satisfied, not you. You see them only once or twice a year, but they see themselves in the mirror every day. Listen to them and try to understand their point of view.
1- If the primary complaint is dullness and rough texture, we usually recommend microdermabrasion using a silk peel dermal infusion, followed by carbon peel using the lutronic spectra nanosecond q-switch laser.
- The microdermabrasion has mechanical resurfacing properties that will help to get rid of the outer layer of the skin immediately (actually, you see the debris of the dead skin in the chamber), it also helps to infuse the serum of choice into the skin, different serums are available.
Please watch this video to know more about microdermabrasion in skin tightening
- The carbon peel is a gentle, yet unique and effective laser skin peel. The technique involves using a mask of colloidal charcoal suspension on the face. The carbon particles ( The size is in the range of micron) will penetrate the disrupted epiderm, remember that in photoaged skin the epidermis is not a fully functional barrier). Once they resided inside the top layer of the skin, these carbon particles act as powerful chromophores. The Lutronic spectra q-switch laser delivers a high energy laser beam in very short pulse width ( in nanosecond range). The carbon particles will convert the laser energy to heat, and since they are buried in the skin, this will heat the skin deep inside. The results are fabulous when it comes to skin glowing, reducing the size of enlarged pores.
Please watch this video to know more about laser carbon peel
2- On the other hand, if the primary complaint is wrinkled, saggy skin, then we have to go for more aggressive treatment. The word aggressive might scare some people, but if the treatment settings are chosen the risk of having adverse incident carefully is very minimal. By saying aggressive, we mean that the treatment is more powerful and that results in higher pain and more extended downtime.
To be able to reach the desired skin tightening results, we need to penetrate the skin deeply (about 3 mm). Two main technologies are able to do so, the Microneedling fractional radio frequency (MFR) (Infini from Lutronic is the industry gold standard MFR system), and Fractional non-abalative Laser (Fraxel Dual is the industry gold standard). Both systems offer great results with skin tightening and work through creating coagulation columns the skin, producing micro-wound environment and urging the skin to heal itself and shed the tired out layers.
Please watch this video to know more about Infini Microneedling system in skin tightening and wrinkle removal
- The microneedling systems are equipped with gold-coated needles (the number of needles varies between 25 to 96 according to the manufactures). Once deep into the skin, the needles release a current of radio frequency that is transformed into heat (due to the electrical resistance of the tissue). The advantages of the microneedling systems are that there is very short downtime, no restriction on sun exposures, no risk of hyperpigmentation. The disadvantages are there is always pinpoint bleeding, high pain endurance and some patient has the “needle-phobia.”
- Fraxel dual laser system has two different wavelengths 1550 and 1927. Both wavelengths use water as a chromophore. Therefore, it is essential for the skin surface to be dry before applying the treatment. Since water is abundant all tissues, including skin, it is mandatory to have the fractional properties. The Fraxel system uses roller tips to deliver the laser in point beams (virtual needles) that penetrate as deep as 3 mm. ( The shorter wavelength has less water affinity, so it penetrate deeper into the skin). The laser will meet the water, as a chromophore) and the energy will turn into heat (photothermolysis).
Please watch this video to know more about Fraxel laser in skin tightening and wrinkle removal
The fractional non-ablative systems have the advantages of having no blood involved or mechanical needles, it is also more efficient if there is pigmentation lesion involved. The main disadvantages are the restricted non-sun exposure or tanning for at least the months and the risk of PIH.
From the discussion above, we can conclude that each machine has its pro and cons. Therefore, it is essential to design a specific protocol for each patient that combine initial and maintenance treatments, along with take-home products, to get the expected results. Please do not hesitate to contact us for a free consultation. We have trained medical esthetician on staff with long experience in Skin tightening, wrinkle removal, acne scar removal, acne treatment, skin care, skin rejuvenation, skin resurfacing, pigmentation removal, melasma treatment, fractional laser, laser hair removal, body shaping and fat removal.
Dr. Kamal Alhallak
Ph.D., MSc, CDE, CRE, APA, MBA candidate
Director of Albany Cosmetic and Laser Centre INC